Provider Demographics
NPI:1881658144
Name:CASTELLON, MAURICIO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:JOSE
Last Name:CASTELLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 S HARBOR CITY BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-729-9909
Mailing Address - Fax:321-728-0288
Practice Address - Street 1:1499 S HARBOR CITY BLVD
Practice Address - Street 2:STE 301
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-729-9909
Practice Address - Fax:321-728-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME819682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51232OtherBLUE CROSS BLUE SHIELD
FL51232AMedicare ID - Type Unspecified
FL51232OtherBLUE CROSS BLUE SHIELD